SP459BOTH LOW AND HIGH SYSTOLIC BLOOD PRESSURE INCREASES THE RISK OF CARDIOVASCULAR EVENTS AND ALL-CAUSE OF MORTALITY IN PATIENTS WITH TYPE 2-DIABETES AND RENAL IMPAIRMENT WITHOUT PREVIOUS CARDIOVASCULAR DISEASE OR CONGESTIVE HEART FAILURE- THE SWEDISH NATIONAL DIABETES REGISTER (NDR)

AbstractPeople with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

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Dapagliflozin and cardiovascular outcomes in patients with Type 2 diabetes

Future Cardiology ◽

10.2217/fca-2019-0065 ◽

2020 ◽

Vol 16 (2) ◽

pp. 77-88

Author(s):

Dalal Y Al-Bazz ◽

John PH Wilding

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Ejection Fraction ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Glucose Lowering ◽

Reduced Ejection Fraction ◽

The Relationship

The relationship between cardiovascular disease, heart failure (HF) and Type-2 diabetes (T2DM) is widely recognized. Cardiovascular (CV) outcome trials are required for all new glucose-lowering agents to confirm safety with respect to CV risk. CV outcome trials with SGLT2i inhibitors have shown CV benefit, with reductions in major CV events and HF. This review focuses on the DECLARE-TIMI 58 trial with dapagliflozin in T2DM, which showed noninferiority for major adverse cardiovascular events and reduction in hospitalization for HF and associated CV mortality in a broad range of patients with T2DM. The DAPA-HF trial of dapagliflozin in people with HF with reduced ejection fraction with and without T2DM confirms benefits for those with HF.

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Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register

Diabetes and Vascular Disease Research ◽

10.1177/1479164116683637 ◽

2017 ◽

Vol 14 (3) ◽

pp. 226-235 ◽

Cited By ~ 2

Author(s):

Maria K Svensson ◽

Henri Afghahi ◽

Stefan Franzen ◽

Staffan Björk ◽

Soffia Gudbjörnsdottir ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Renal Impairment ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Hazard Ratio ◽

All Cause Mortality ◽

Diabetes Register

Background: Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. Aims: To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. Patients and methods: A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. Results: A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13–1.40 and hazard ratio: 1.26, 1.17–1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (−10 to −25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17–1.32). Conclusion: Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

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Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register

Diabetes and Vascular Disease Research ◽

10.1177/1479164116637311 ◽

2016 ◽

Vol 13 (4) ◽

pp. 268-277 ◽

Cited By ~ 11

Author(s):

Katarina Eeg-Olofsson ◽

Björn Zethelius ◽

Soffia Gudbjörnsdottir ◽

Björn Eliasson ◽

Ann-Marie Svensson ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Systolic Blood Pressure ◽

Reference Group ◽

Baseline Hba1c ◽

Diabetes Register

Objectives: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. Methods: Observational study of 13,477 females and males aged 30–75 years, with baseline HbA1c 41–67 mmol/mol, systolic blood pressure 122–154 mmHg and ratio non-HDL:HDL 1.7–4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group ( n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c ( n = 1925), HbA1c and systolic blood pressure ( n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL ( n = 2745). Results: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. Conclusion: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.

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Sodium–Glucose Cotransporter–2 (SGLT-2) Inhibitors and the Treatment of Type 2 Diabetes

Annual Review of Medicine ◽

10.1146/annurev-med-042017-094221 ◽

2019 ◽

Vol 70 (1) ◽

pp. 323-334 ◽

Cited By ~ 10

Author(s):

Caroline K. Kramer ◽

Bernard Zinman

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cardiovascular Events ◽

Acute Effect ◽

Metabolic Effects ◽

Major Adverse Cardiovascular Events ◽

Cardiovascular Safety ◽

Sodium Glucose Cotransporter

Clinical studies evaluating the cardiovascular safety/impact of sodium–glucose cotransporter–2 (SGLT-2) inhibitors demonstrated a reduction in major adverse cardiovascular events driven primarily by a reduced cardiovascular mortality in individuals with type 2 diabetes and previous cardiovascular disease. These somewhat unexpected results are coupled with SGLT-2 inhibitors’ known acute effect of improvement in glycemia, reduction in blood pressure, and weight loss. In this review, we summarize the mechanism of action of SGLT-2 inhibitors, the metabolic effects of this class of medication, and the remarkable results of cardiovascular safety trials. In addition, we discuss adverse effects associated with these medications and the current recommendations for the use of these agents in the management of diabetes.

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Current Utilization Trends of SGLT-2 Inhibitors in Type 2 Diabetics With Heart Failure

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.832 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A408-A409

Author(s):

Puneet Dhillon ◽

Harshwant Grover ◽

Shujaul Haq ◽

Tirth Patel ◽

Usama Sadiq ◽

...

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cardiovascular Events ◽

Sglt2 Inhibitor ◽

Sglt2 Inhibitors ◽

Inclusion Criteria ◽

Type 2 Diabetics ◽

Current Utilization

Abstract Background: Sodium glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a recent addition to the armamentarium for treating type 2 diabetes. Over the last couple of years, these agents have been studied in patients with cardiovascular disease, particularly heart failure. Results of the EMPA-REG (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), CANVAS (Canagliflozin Cardiovascular Assessment Study) and DECLARE-TIMI (Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction) have clearly shown SGLT2 inhibitors to be beneficial for patients with heart failure. FDA has approved Canagliflozin and Dapagliflozin for reduction of risk of adverse cardiovascular events in patients with Type 2 Diabetes with established Cardiovascular disease. This study was conducted to determine the current utilization trends of SGLT2 inhibitors in Type 2 Diabetics admitted with congestive heart failure exacerbation at Abington Memorial Hospital. Methods: The study was an observational retrospective chart review of 287 patients who were admitted to the telemetry floor with an admitting diagnosis of Congestive Heart Failure with a concomitant diagnosis of Type 2 Diabetes from 06/01/2019 to 11/30/2019. 186 patients met the inclusion criteria. Results: Mean age of the patient population was 69 years. Mean ejection fraction was 39%. Mean A1C was 7.7. Out of 186 patients who met the inclusion criteria, 2 patients were on SGLT2 inhibitor on admission and were discharged on it. 1 patient was started on a SGLT2 inhibitor during hospitalization and was discharged on it. Out of our patient population, only 1.6% of the patients were discharged on SGLT2 inhibitor. Conclusion: Even after FDA approval of SGLT-2 inhibitors in reducing heart failure hospitalizations in patients with known history of Type 2 diabetes and heart failure, the utilization of these drugs is very minimal. No other drug has been proven to improve mortality in patients of heart failure with preserved ejection fraction. Based on the results of this study, we propose that initiation of SGLT2 inhibitor should be one of the core measures during discharge of Type 2 Diabetics after a hospitalization with Heart Failure.

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Cardiovascular Disease among Breast Cancer Survivors

10.31487/j.cdm.2020.01.01 ◽

2020 ◽

pp. 1-5

Author(s):

Steven S. Coughlin ◽

Ban Majeed ◽

Deepak Ayyala ◽

Gaston Kapuku ◽

Letisia Cortes ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Congestive Heart Failure ◽

Cancer Survivors ◽

Cardiovascular Events ◽

Breast Cancer Survivors ◽

History Of

Background: Among breast cancer survivors age > 50 years, deaths due to cardiovascular disease account for 35% of non-cancer related deaths. The increases in cardiovascular disease among breast cancer survivors is due to the cardiotoxic effects of breast cancer treatment and to overlapping risk factors for breast cancer and cardiovascular disease. Methods: We conducted a study of a sample of 164 breast cancer patients in order to examine the frequency of cardiovascular disease. The overall objective was to examine the frequency of high blood pressure, myocardial infarction, cardiomyopathy, congestive heart failure, stroke, and venous thrombosis/thromboembolism among women who have been diagnosed with stage I-IV breast cancer and who had completed primary therapy for the disease. Data were collected by postal survey and abstraction of electronic medical records. Results: A high percentage of the women (62.8%) had a reported history of high blood pressure. Fifty percent of the women had a reported history of high cholesterol. About 8.3% of the women were current smokers and 36.0% were former smokers. About 23.8% of the women had a reported history of diabetes. About 4.9% of the women had a reported history of congestive heart failure and 6.1% had a history of stroke. Discussion: Additional studies are needed of cardiovascular risk factors and adverse cardiovascular events among breast cancer survivors. Of particular concern is whether patients with hypertension, hypercholesterolemia, and diabetes are receiving appropriate therapy to reduce their cardiovascular risk and prevent morbidity and mortality from adverse cardiovascular events.

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